Pratique du Shadowing: Embolization of AV Malformations: Tips and Tricks - Apprendre l'anglais à l'oral avec YouTube
C2
Hi.
186 phrases
Si les phrases sont trop courtes ou trop longues, cliquez sur Edit pour les ajuster.
1
Hi.
2
I'd like to thank the organizers for inviting me here today.
3
So this is going to be a pretty quick review as well because it's kind of a complex topic.
4
So I'm going to focus mainly on the technical part of embolization procedures.
5
These are disclosures.
6
And so the AVM, as we all know,
7
are abnormal connections between arteries and veins.
8
Typically with the intervening nidus or collection of abnormal vessels with feeding arteries and draining veins.
9
They can be divided into different types,
10
the top being more fistulist-type connections,
11
which are a direct artery into a venous sac
12
and then going down to multiple arteries coming into a nidus and then an outflowing vein.
13
And these have been related to different genetic diseases,
14
such as hemorrhagic hereditary telangiectasia 1 and 2, capillary malformation AVM syndrome.
15
Then they—these do have genes associated with them,
16
but most AVMs are actually sporadic.
17
And then in, I am a neurointerventionalist,
18
so we divide our AVMs into many different types.
19
I'm not going to go over it very laboriously,
20
but depending on where it's located,
21
so in the cerebral matter itself,
22
peel malformations are ranging from nidal-type malformations to fistulas,
23
which occur mainly in pediatrics.
24
and galen malformations occur mainly in newborns.
25
And then there are malformations that are more fistulas
26
and acquired later in life that occur in the dura or lining of the brain.
27
And this can be found in the carotid cavernous region where you can also find direct fistulas from trauma.
28
And then there's a whole organization for spinal AVMs as well.
29
And so how, you know,
30
to get to the embolization part,
31
how do we close these malformations?
32
The focus and the goal really is to treat the nidus in the case of nidal aneurysms
33
and close this connection as well as in the fistula's connection,
34
the focus is really to get to the proximal part of the vein that's receiving the arteries and close that.
35
are sometimes used in these cases,
36
but actually less so because you really can only get to these medium-sized arteries or smaller,
37
even tinier arteries with coils,
38
so you can't really get good penetration into the nidus itself.
39
There have been use of sclerosing agents,
40
so taking a micro catheter sorry into a feeding artery injecting ethanol 100% ethanol to kind of burn the malformation
41
and and destroy it in that way but the more common uses liquid agents
42
and that can be there are really two
43
that are in use in the US right now there's NBC a which is a cyanoacrylate and then there's onyx
44
which is a polymer, and I'll go into those.
45
And then there's some neuroagents in development,
46
and these can be placed into the nidus or into the vein via a transarterial or a transvenous approach.
47
NBCA is closely related to crazy glue.
48
It's an adhesive, so it sticks to the arteries.
49
And the goals, as with any embolization of AVM,
50
is good penetration into the nidus.
51
And with NBCA, it is,
52
once it contacts the blood, it polymerizes very quickly.
53
And so you want to prevent proximal reflux along the catheter,
54
as prolonged contact with the catheter will cause adhesion to it.
55
And you can have a retained catheter or vessel injury when you try to pull it out.
56
Onyx was developed and approved by the FDA in the 1990s and actually in the mid-2000s.
57
And this is a copolymer of ethylene vinyl alcohol.
58
It's dissolved in a solvent, DMSO.
59
And then there's suspended micronized tantalum powder in it to achieve radio radio opacity,
60
so it needs to be shaken right before you inject it or else all the tantalum will settle out of it.
61
And then the traditional method of injecting onyx is to inject,
62
and it looks like this dark color because of the tantalum within it,
63
so you inject little bits along the tip of the microcatheter until you fill the proximal artery here,
64
refluxing a little bit along the catheter.
65
And then as soon as you create,
66
the goal of that is to create a plug within the proximal artery at the location of the tip of the catheter.
67
And then once you create that plug,
68
when you inject, it's going to go forward and penetrate into the nidus.
69
So like I said, a proximal plug is used,
70
and the catheter needs to be removed from the embolic cast at the end of the embolization.
71
So even though Onyx is not adhesive,
72
it can be, if you reflux too much along the catheter,
73
this can lead to a retained microcatheter as well,
74
just because of friction in trying to remove it.
75
And if you then pull too hard,
76
this can lead to rupture and hemorrhage.
77
So the tips and tricks,
78
I'm really just going to talk about a few newer techniques that we're using in the last few years.
79
And one of them is,
80
and it has to do with newer technology that's coming out.
81
So one is the use of the detachable tip microcatheter,
82
which is called the Apollo microcatheter.
83
And it's a single lumen catheter.
84
It has a tip that's actually held into a shaft here by pressure, by friction.
85
And this allows for a force being required to actually separate the two.
86
So it's less than a third of the force that you would need to actually break any other part of the catheter.
87
So it's thought that it's a more gentle force of retrieving the catheter.
88
And you basically just pull slowly and stretch and stretch until it detaches or the whole thing pulls out of the onyx.
89
And this catheter comes with two tips.
90
So this is the distal tip,
91
the proximal marker here is where the detachment zone is.
92
So you can't, if you're injecting and you reflux all the way to this point,
93
you have to stop because you're going to then glue that detachment zone in place.
94
And this is an example of a vertebral peel fistula.
95
So this is an AP view and a lateral view,
96
the vertebral artery in the neck,
97
and this fistula's connection to posterior fossa vein.
98
And this is a navigation of the Apollo catheter to the fistula.
99
You could see it in place,
100
the distal marker and the proximal marker.
101
And there you see an injection of NBCA.
102
So this catheter can be used with both NBCA and ONIX.
103
And in this case, it looks like the catheter was completely removed without detaching.
104
So then in a second injection,
105
another Apollo catheter was brought up to a second fistula site.
106
And there's some injection of contrast showing the direct connection to the vein.
107
And this is a video here.
108
And this is high concentration of NBCA.
109
So this really, if you were using any standard microcatheter,
110
you would not keep it there that long because you'd be afraid of actually polymerizing and gluing the catheter in place.
111
But because now that we have the detachable tip,
112
we're more comfortable trying to get good penetration with NBCA.
113
And so that's the injection.
114
You can see more NBCA filling into the venous side of the fistula,
115
and then pull and out.
116
And then you can see kind of tiny here,
117
but that's the distal tip, and that's the catheter.
118
So it's actually detached, and the distal tip of it is left in place.
119
So the advantages with Onyx,
120
you make reflux purposefully to create a plug,
121
so you know how much you can reflux.
122
And with the NBCA, you have a controlled injection instead of trying to inject quickly and then pull it out.
123
So this allows for better penetration.
124
And then it requires less pressure to remove the catheter,
125
so less chance of injuring.
126
The disadvantage, it is a bit stiffer at the detachment zone,
127
so the connection between the tip and the proximal microcatheter
128
compared with the rest of the microcatheter and with some other softer microcatheters that we may use.
129
And then we've had now two cases where on navigating the catheter without attempting to detach the tip,
130
it's inadvertently detached in a proximal artery.
131
So that's something that that if you're navigating in torturous anatomy, it can happen.
132
And that's the tip.
133
So the other thing that's come about is the development of DMSO compatible balloon microcatheters.
134
So these are the SEPTR balloons.
135
And it's just, it's a dual lumen catheter.
136
So you have a lumen that you can inject onyx or glue or coils,
137
whatever you want, whatever you're doing,
138
and then a second port to inflate this balloon.
139
And then this is a case,
140
so this really allows for a really good penetration without having to worry about reflux or make a plug.
141
So So this is a case of a maxillary arteriovenous malformation.
142
This is the internal maxillary, the patient's maxilla.
143
And you see this abnormal AVM, capillary-type AVM right here.
144
And then this is the balloon catheter in place.
145
So it's in this branch here.
146
And this is the inflation of the balloon.
147
So you create a plug just by inflating the balloon.
148
It's very quick.
149
And then you can achieve great penetration into the entire AVM.
150
This required injection into a couple different feeders,
151
but by using this technique,
152
I was able to completely treat.
153
And at the end of this treatment,
154
there was no remaining shunting.
155
The important thing when you're using Onyx is you have to be able to recognize abnormal and normal and know your,
156
especially in the head and neck,
157
you have to know where you're located.
158
Avoid any abnormal connections to the internal carotid circulation
159
or any normal connections that you might not see
160
but you know are there because the onyx with this technique can penetrate into small collaterals that are otherwise closed.
161
And then just as This is a last example.
162
This is a 42-year-old man with headaches and tinnitus,
163
and he got this MRA,
164
which shows this markedly abnormal enlarged vessels on the left side of his head from external and as well internal circulation,
165
and all going into the left transverse sinus.
166
This is a typical dural arteriovenous fistula, and usually acquired.
167
This is the MRA showing that fistula.
168
You see some external carotid artery,
169
occipital branches, middle meningeal branches,
170
and then on angiography marked dilatation of these branches.
171
And really on the CAT scan,
172
we can see that they really all come down to this connection right here into the transverse sinus,
173
or so we thought.
174
However, when we closed that off,
175
we realized that the fistulas were coming to multiple locations along that sinus.
176
And this is one disadvantage of ONIX.
177
So after you have to close such a complex malformation with multiple vessels,
178
you're left with this sort of picture in which you can't really see anything afterwards.
179
So that leads to my last point,
180
which is the development of this new liquid embolic called Phil,
181
which is currently approved in Europe.
182
And this is going to be,
183
it's going to have iodine attached to the copolymer.
184
And so therefore that should absorb and it will be less radio-opaque when you come back for later treatments.
185
And that's it.
186
Thank you for your attention.
Télécharger l'application
Notation IA pour chaque phrase que vous prononcez
TRENDING
Populaires
Why practice speaking with this video?
This video offers a valuable opportunity for English speaking practice in a specialized medical context. Learning to articulate complex medical topics can significantly enhance your vocabulary and boost your confidence when discussing challenging subjects. Engaging with this material allows you to practice speaking in a structured manner, helping you to improve comprehension and retention of medical terminology. By shadowing the speaker, you can not only mimic their pronunciation but also absorb key phrases and expressions commonly used in the field of neurointerventional medicine.
Grammar & Expressions in Context
In this video, the speaker employs several notable structures that are beneficial for learners:
- Complex sentences: The speaker uses sentences with multiple clauses to convey intricate ideas, such as "these can be divided into different types, the top being more fistulist-type connections."
- Passive voice: The use of phrases like "are related to different genetic diseases" highlights an important aspect of scientific discourse—focusing on the action rather than the subject.
- Present continuous tense: The speaker employs present continuous for ongoing actions, e.g., "how do we close these malformations?" This structure is useful for discussing processes and procedures.
- Terminology explanation: The speaker clarifies complex terms by offering explanations, which can help learners in their own discussions in English. For instance, defining "nidus" and "fistulas" aids comprehension.
Common Pronunciation Traps
As you practice your English pronunciation, pay close attention to the following words and phrases from the video:
- Embolization: This medical term can be tricky due to its length and syllable stress; practice breaking it down into smaller parts.
- Nidus: The pronunciation of this term can be challenging; ensure you practice the stress on the first syllable.
- Cyanoacrylate: A complicated term that includes multiple syllables; slow pronunciation will help you master it.
Utilizing a shadowing app can assist you in repeating these terms accurately. By using tools like this, you can improve your pronunciation and speaking fluency by mimicking how the speaker articulates these complex terms in context.
Qu'est-ce que la technique du Shadowing ?
Le Shadowing est une technique d'apprentissage des langues fondée sur la science, développée à l'origine pour la formation des interprètes professionnels. Le principe est simple mais puissant : vous écoutez de l'anglais natif et le répétez immédiatement à voix haute — comme une ombre suivant le locuteur avec un décalage de 1 à 2 secondes. Les recherches montrent une amélioration significative de la précision de la prononciation, de l'intonation, du rythme, des liaisons, de la compréhension orale et de la fluidité.
☕ Offrez-nous un café
ShadowingEnglish reste 100% gratuit grâce à votre soutien. Les coûts des serveurs et de l'IA sont élevés — votre café nous aide à continuer ! 🙏